Fort Lee Vision LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

27OA00602800 Issued in NJ

Legal business name

FORT LEE VISION LLC

Practice address

2151 Lemoine Ave
Fort Lee, NJ 07024-6041

Phone

(201) 346-9000

Fax

(201) 346-9001

NPI assigned

Dec 7, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Diane M. Kim, O.D.NPI 1710945589

Title

O.D./Owner

Phone

(201) 346-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fort Lee Vision Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diane M. Kim, OD

  • Optometrist
  • Fort Lee, NJ
  • NPI 1710945589
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1003144833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 LEMOINE AVE",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246041",
            "telephone_number": "201-346-9000",
            "fax_number": "201-346-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 LEMOINE AVE",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "070246041",
            "telephone_number": "201-346-9000",
            "fax_number": "201-346-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT LEE VISION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-07",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "O.D./OWNER",
        "authorized_official_telephone_number": "201-346-9000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NJ",
            "license": "27OA00602800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0122874",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Lee Vision",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Raymond Fung, M.P.T.

• Eyewear Supplier in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Eyewear Supplier in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.